Author response:
The following is the authors’ response to the original reviews.
Reviewer #1 (Public Review):
Summary:
The authors constructed a novel HSV-based therapeutic vaccine to cure SIV in a primate model. The novel HSV vector is deleted for ICP34.5. Evidence is given that this protein blocks HIV reactivation by interference with the NF-kB pathway. The deleted construct supposedly would reactivate SIV from latency. The SIV genes carried by the vector ought to elicit a strong immune response. Together the HSV vector would elicit a shock and kill effect. This is tested in a primate model.
Thank you for your kind comments and suggestions, which are very helpful in improving our manuscript. We have carefully revised our manuscript and performed additional experiments accordingly, and we now think this version has been substantially improved for your reconsideration.
Strengths and weaknesses:
(1) Deleting ICP34.5 from the HSV construct has a very strong effect on HIV reactivation. Why is no eGFP readout given in Figure 1C as for WT HSV? The mechanism underlying increased activation by deleting ICP34.5 is only partially explored. Overexpression of ICP34.5 has a much smaller effect (reduction in reactivation) than deletion of ICP34.5 (strong activation); so the story seems incomplete.
Thank you for your careful review and kind reminder.
(1) We are sorry for the misunderstanding of Figure 1C. In the experiment of Figue 1C, we used an HSV-1 17 strain containing GFP (HSV-GFP) and HSV-DICP34.5 (recombinant HSV-1 17 strain with ICP34.5 deletion based on HSV-GFP) to reactivate the HIV latency cell line (J-Lat 10.6 cell). Since detecting GFP cannot distinguish between HSV infection and HIV reactivation, we assessed the reactivation by measuring the mRNA levels of HIV LTR upon stimulation with either HSV-GFP or HSV-ΔICP34.5. Actually, in Figure 1B, we had verified the reactivation efficacy by infecting J-Lat 10.6 cells with the HSV-1 17 strain containing GFP (HSV-GFP) and found significant upregulation of mRNA levels of HIV-1 LTR, Tat, Gag, Vif, and Vpr. We have adjusted the corresponding descriptions accordingly in the revised manuscript.
(2) We agree with your insightful mention that the mechanism underlying increased activation by HSV-ΔICP34.5 is worthy to be further explored in the future study. In this study, we found that ICP34.5 play an antagonistic role with the reactivation of HIV latency by HSV-1 mainly through the modulation of host NF-κB and HSF1 pathways, while HSV-1 (especially HSV-ΔICP34.5) might reactivate HIV latency through NF-κB, HSF1, and other yet-to-be-determined mechanisms. Thus, ICP34.5 overexpression can only a partial effect on the reduction of the HIV latency reactivation by HSV-1. We have mentioned this issue in the revised “Discussion section”. “Intriguingly, these findings collectively indicated that ICP34.5 might play an antagonistic role in the reactivation of HIV by HSV-1, and thus our modified HSV-DICP34.5 constructs can effectively reactivate HIV/SIV latency through the release of imprisonment from ICP34.5. However, ICP34.5 overexpression had only a partial effect on the reduction of the HIV latency reactivation, indicating that HSV-DICP34.5-based constructs can also reactivate HIV latency through other yet-to-be-determined mechanisms.” (Lines 334 to 340).
(2) No toxicity data are given for deleting ICP34.5. How specific is the effect for HIV reactivation? An RNA seq analysis is required to show the effect on cellular genes.
Thank you for your questions and suggestions.
(1) It’s well known that ICP34.5 is a neurotoxicity factor that can antagonize host immune responses, and previous studies (in gene therapy and oncolytic virotherapy) have shown that the safety of recombinant HSV-based vector can be improved by deleting ICP34.5. In this study, we also found that HSV-DICP34.5 exhibited lower virulence and replication ability than its parental strain (HSV-GFP) (Figure 1D, Figure S1). In addition, HSV-DICP34.5 induced a lower level of inflammatory cytokines (including IL-6, IL-1β, and TNF-α) in primary CD4+ T cells from PLWH compared to HSV-GFP stimulation, likely due to its lower virulence and replication ability (Figure 1I-K). In addition, the CD4+ /CD8+ T cell ratio (Figure 5I) and body weight (Figure S9) after treatment were effectively ameliorated in the SIV-infected macaques of the ART+HSV-DICP34.5-sPD1-SIVgag/SIVenv group. Our data also demonstrated that there was no significant effect on the cell composition of peripheral blood in the SIV-infected macaques of ART+HSV-sPD1-SIVgag/SIVenv group (Figure S10). Thus, these data suggest the safety of HSV-DICP34.5 in PLWH might be tolerable. We have added the corresponding description in the revised manuscript.
(2) In our study, we found both adenovirus and vaccinia virus cannot reactivate HIV latency (Figure S3). In addition, the deletion of ICP0 gene from HSV-1 diminished the reactivation effect of HIV latency by HSV-1 (Figure S4). Thus, these data suggested the reactivation of HIV latency by HSV-1 might be virus-specific. Of course, this might be further investigated in future studies. We have added the corresponding description in the revised manuscript.
(3) To explore the mechanism of reactivating viral latency by HSV-DICP34.5-based constructs, we performed RNA-seq analysis (Figure S5). We have added the corresponding description accordingly in the revised manuscript.
(3) The primate groups are too small and the results to variable to make averages. In Figure 5, the group with ART and saline has two slow rebounders. It is not correct to average those with a single quick rebounder. Here the interpretation is NOT supported by the data.
We agree with you that this is a pilot study with limited numbers of rhesus macaques. Although the number of macaques was relatively limited, these nine macaques were distributed evenly based on the background level of age, sex, weight, CD4 count, and viral load (VL) (Table S2). All SIV-infected macaques used in this study had a long history of SIV infection and had several courses of ART therapy, which mimics treatment of chronic HIV-1 infection in humans. These macaques were infected with SIVmac239 for more than 5 years, and highly pathogenic SIV-infected macaques have been well-validated as a stringent model to recapitulate HIV-1 pathogenesis and persistence during ART therapy in humans. Indeed, in our Chinese rhesus model, ART treatment effectively suppressed SIV infection to undetectable levels in plasma, and upon ART discontinuation, virus rapidly rebounded, which is very similar with that in ART-treated HIV patients. We think the results of this pilot study were very promising for further studies which will be expanded the scale of animals and then to preclinical and clinical study in our next projects. Thank you for your understanding.
As for your question regarding “the two animals with low VL and slow rebound”, our explanation is following: As mentioned above, these macaques were distributed evenly based on the background level of CD4 count and VL (Table S2), and then there were different change of viral load and viral rebound in different groups. Thus, we think these data can support our interpretation. Moreover, our conclusion can also be supported from at least three evidences.
(1) The VL in the ART+saline group promptly rebounded after ART discontinuation, with an average 8.63-fold increase in the rebounded peak VL compared with the pre-ART VL (Figure 5A, D and E). However, plasma VL in the ART+HSV-sPD1-SIVgag/SIVenv group exhibited a delayed rebound interval (Figure 5B-D).
(2) There was a lower rebounded peak VL than pre-ART VL in the ART+HSV-sPD1-SIVgag/SIVenv group (average 12.20-fold decrease), while a higher rebounded peak VL than pre-ART VL in the ART+HSV-empty group (average 2.74-fold increase) (Figure 5E).
(3） We found significant suppression of total SIV DNA and integrated SIV DNA provirus in the ART+HSV-sPD1-SIVgag/SIVenv group. However, the copies of the SIV DNA provirus were significantly improved in the ART+HSV-empty group and ART+saline group (Figure 5F-G).
Thank you for your understanding.
Discussion
HSV vectors are mainly used in cancer treatment partially due to induced inflammation. Whether these are suitable to cure PLWH without major symptoms is a bit questionable to me and should at least be argued for.
Thank you for your kind question comment and question. We confirmed the enhanced reactivation of HIV latency by HSV-∆ICP34.5 in primary CD4+ T cells from people living with HIV (PLWH) (Figure S2). As mentioned above, previous studies have shown that the safety of recombinant HSV-based vector can be improved by deleting ICP34.5. In this study, we also found that HSV-DICP34.5 exhibited lower virulence and replication ability than its parental strain (HSV-GFP) (Figure 1D, Figure S1). In addition, HSV-DICP34.5 induced a lower level of inflammatory cytokines (including IL-6, IL-1β, and TNF-α) in primary CD4+ T cells from PLWH compared to HSV-GFP stimulation, likely due to its lower virulence and replication ability (Figure 1I-K). In addition, the CD4+ /CD8+ T cell ratio (Figure 5I) and body weight (Figure S9) after treatment were effectively ameliorated in the SIV-infected macaques of the ART+HSV-DICP34.5-sPD1-SIVgag/SIVenv group. Our data also demonstrated that there was no significant effect on the cell composition of peripheral blood in the SIV-infected macaques of ART+HSV-sPD1-SIVgag/SIVenv group (Figure S10). Thus, these data suggest the safety of HSV-DICP34.5 in PLWH might be tolerable. We have added the corresponding description in the revised manuscript.
Reviewer #2 (Public Review):
Summary:
In this article, Wen et. al. describe the development of a 'proof-of-concept' bi-functional vector based on HSV-deltaICP-34.5's ability to purge latent HIV-1 and SIV genomes from cells. They show that co-infection of latent J-lat T-cell lines with an HSV-deltaICP-34.5 vector can reactivate HIV-1 from a latent state. Over- or stable expression of ICP 34.5 ORF in these cells can arrest latent HIV-1 genomes from transcription, even in the presence of latency reversal agents. ICP34.5 can co-IP with- and de-phosphorylate IKKa/b to block its interaction with NF-k/B transcription factor. Additionally, ICP34.5 can interact with HSF1 which was identified by mass-spec. Thus, the authors propose that the latency reversal effect of HSV-deltaICP-34.5 in co-infected JLat cells is due to modulatory effects on the IKKa/b-NF-kB and PP1-HSF-1 pathway.
Next, the authors cleverly construct a bifunctional HSV-based vector with deleted ICP34.5 and 47 ORFs to purge latency and avoid immunological refluxes, and additionally, expand the application of this construct as a vaccine by introducing SIV genes. They use this 'vaccine' in mouse models and show the expected SIV-immune responses. Experiments in rhesus macaques (RM), further elicit the potential for their approach to reactivate SIV genomes and at the same time block their replication by antibodies. What was interesting in the SIV experiments is that the dual-functional vector vaccine containing sPD1- and SIV Gag/Env ORFs effectively delayed SIV rebound in RMs and in some cases almost neutralized viral DNA copy detection in serum. Very promising indeed, however, there are some questions I wish the authors had explored to get answers to, detailed below.
Overall, this is an elegant and timely work demonstrating the feasibility of reducing virus rebound in animals, with the potential to expand to clinical studies. The work was well-written, and sections were clearly discussed.
Strengths:
The work is well designed, rationale explained, and written very clearly for lay readers.
Claims are adequately supported by evidence and well-designed experiments including controls.
Thank you for your nice comments regarding our work.
Weaknesses:
(1) While the mechanism of ICP34.5 interaction and modulation of the NF-kB and HSF1 pathways are shown, this only proves ICP34.5 interactions but does not give away the mechanism of how the HSV-deltaICP-34.5 vector purges HIV-1 latency. What other components of the vector are required for latency reversal? Perhaps serial deletion experiments of the other ORFs in the HSV-deltaICP-34.5 vector might be revealing.
Thank you for your valuable suggestion. In fact, we are currently further exploring some potential viral genes of HSV-1 that might play a role in the reactivation of HIV latency. We have found that the deletion of ICP0 gene from HSV-1 diminished the reactivation effect of HIV latency by HSV-1 (Figure S4), showing that ICP0 might play a vital role for the reactivation. Of course, this might be further investigated in future studies. We have added the corresponding description in the revised manuscript.
(2) The efficacy of the HSV vaccine vectors was evaluated in Rhesus Macaque model animals. Animals were chronically infected with SIV (a parent of HIV), treated with ART, challenged with bi-functional HSV vaccine or controls, and discontinued treatment, and the resulting virus burden and immune responses were monitored. The animals showed SIV Gag and Env-specific immune responses, and delayed virus rebound (however rebound is still there), and below-detection viral DNA copies. What would make a more convincing argument to this reviewer will be data to demonstrate that after the bi-functional vaccine, the animals show overall reduction in the number of circulating latent cells. The feasibility of obtaining such a result is not clearly demonstrated.
Thank you for your valuable mention. We have now provided more data about this issue. We found significant suppression of total SIV DNA and integrated SIV DNA provirus in the ART+HSV-sPD1-SIVgag/SIVenv group. However, the copies of the SIV DNA provirus were significantly improved in the ART+HSV-empty group and ART+saline group (Figure 5F-G). We have added the corresponding description in the revised manuscript.
(3) The authors state that the reduced virus rebound detected following bi-functional vaccine delivery is due to latent genomes becoming activated and steady-state neutralization of these viruses by antibody response. This needs to be demonstrated. Perhaps cell-culture experiments from specimens taken from animals might help address this issue. In lab cultures one could create environments without antibody responses, under these conditions one would expect a higher level of viral loads to be released in response to the vaccine in question.
Thanks for your kind mention and suggestion. We performed the following cell experiment to address this issue. Primary CD4+ T cells from people living with HIV (PLWH) were isolated, and then infected with HSV or HSV-∆ICP34.5 constructs. As expected, we confirmed the enhanced reactivation of HIV latency by HSV-∆ICP34.5 (Figure S2). Thank you.
(4) How do the authors imagine neutralizing HIV-1 envelope epitopes by a similar strategy? A discussion of this point may also help.
Thank you for your kind comment. We have added the corresponding discussion in the revised manuscript. “The current consensus on HIV/AIDS vaccines emphasizes the importance of simultaneously inducing broadly neutralizing antibodies and cellular immune responses. Therefore, we believe that incorporating the induction of broadly neutralizing antibodies into our future optimizing approaches may lead to better therapeutic outcomes.” (Lines 384 to 388)
(5) I thought the empty HSV-vector control also elicited somewhat delayed kinetics in virus rebound and neutralization, can the authors comment on why this is the case?
Thank you for your careful review and mention. We agree with you that the HSV-1 empty vector does exhibit somewhat a delayed rebound. We think the possible reason is: Although the empty HSV-vector cannot elicit SIV-specific CTL responses, it effectively activates the latent SIV reserviors, and then these activated virions can be partially killed by ART drugs. Therefore, even without carrying HIV/SIV antigens, somewhat delayed kinetics in virus rebound may be observed. Thank you.
Reviewer #1 (Recommendations For The Authors):
(1) The authors should provide toxicity data for HSV transduction after deleting ICP34.5 and provide an explanation of why overexpression of ICP34.5 has such a small effect.
Thank you for your questions and suggestions. As mentioned above, we now provided data for the safety of HSV-DICP34.5-based constructs.
(1) It’s well known that ICP34.5 is a neurotoxicity factor that can antagonize host immune responses, and previous studies (in gene therapy and oncolytic virotherapy) have shown that the safety of recombinant HSV-based vector can be improved by deleting ICP34.5. In this study, we also found that HSV-DICP34.5 exhibited lower virulence and replication ability than its parental strain (HSV-GFP) (Figure 1D, Figure S1). In addition, HSV-DICP34.5 induced a lower level of inflammatory cytokines (including IL-6, IL-1β, and TNF-α) in primary CD4+ T cells from PLWH compared to HSV-GFP stimulation, likely due to its lower virulence and replication ability (Figure 1I-K). In addition, the CD4+ /CD8+ T cell ratio (Figure 5I) and body weight (Figure S9) after treatment were effectively ameliorated in the SIV-infected macaques of the ART+HSV-DICP34.5-sPD1-SIVgag/SIVenv group. Our data also demonstrated that there was no significant effect on the cell composition of peripheral blood in the SIV-infected macaques of ART+HSV-sPD1-SIVgag/SIVenv group (Figure S10). Thus, these data suggest the safety of HSV-DICP34.5 in PLWH might be tolerable. We have added the corresponding description in the revised manuscript.
(2) We agree with your insightful mention that the mechanism underlying increased activation by HSV-ΔICP34.5 is worthy to be further explored in the future study. In this study, we found that ICP34.5 play an antagonistic role with the reactivation of HIV latency by HSV-1 mainly through the modulation of host NF-κB and HSF1 pathways, while HSV-1 (especially HSV-ΔICP34.5) might reactivate HIV latency through NF-κB, HSF1, and other yet-to-be-determined mechanisms. Thus, ICP34.5 overexpression can only a partial effect on the reduction of the HIV latency reactivation by HSV-1. We have mentioned this issue in the revised “Discussion section”. “Intriguingly, these findings collectively indicated that ICP34.5 might play an antagonistic role in the reactivation of HIV by HSV-1, and thus our modified HSV-DICP34.5 constructs can effectively reactivate HIV/SIV latency through the release of imprisonment from ICP34.5. However, ICP34.5 overexpression had only a partial effect on the reduction of the HIV latency reactivation, indicating that HSV-DICP34.5-based constructs can also reactivate HIV latency through other yet-to-be-determined mechanisms.” (Lines 334 to 340).
(2) How specific is the effect for HIV reactivation? An RNA seq analysis is required to show the effect on cellular genes.
Thank you for your questions and suggestions.
(1) In our study, we found both adenovirus and vaccinia virus cannot reactivate HIV latency (Figure S3). In addition, the deletion of ICP0 gene from HSV-1 diminished the reactivation effect of HIV latency by HSV-1 (Figure S4). Thus, these data suggested the reactivation of HIV latency by HSV-1 might be virus-specific. Of course, this might be further investigated in future studies. We have added the corresponding description in the revised manuscript.
(2) To explore the mechanism of reactivating viral latency by HSV-DICP34.5-based constructs, we performed RNA-seq analysis (Figure S5). Results showed that there were numerous differentially expressed genes (DEGs) in response to HSV-ΔICP34.5 infection. Among them, 2288 genes were upregulated, and 611 genes were downregulated. GO analysis showed the enrichment of these DEGs in cellular cycle, cellular development, and cellular proliferation, and KEGG enrichment analysis indicated the enrichment in pathways such as cellular cycle and cytokine-cytokine receptor interaction. We have added the corresponding description accordingly in the revised manuscript.
(3) A comparison in primates has to be given for constructs with or without ICP34.5 to validate cell culture data (what is an empty vector?)
Thank you for your reminder. In the revised manuscript, we performed the following cell experiment to address this issue. Primary CD4+ T cells from people living with HIV (PLWH) were isolated, and then infected with HSV or HSV-∆ICP34.5 constructs. As expected, we confirmed the enhanced reactivation of HIV latency by HSV-∆ICP34.5 (Figure S2). Thank you.
(4) Legends should be improved in writing and content.
Thank you for your kind mention. In the revised version, we have improved both the manuscript content and the legends of all Figures have been carefully revised in writing and content. Thank you.
(5) The primate groups should be enlarged before any reliable conclusions can be made. Inflammatory/tox data should be provided.
Thank you for your question.
(1) As mentioned above, we agree with you that this is a pilot study with limited numbers of rhesus macaques. Although the number of macaques was relatively limited, these nine macaques were distributed evenly based on the background level of age, sex, weight, CD4 count, and viral load (VL) (Table S2). All SIV-infected macaques used in this study had a long history of SIV infection and had several courses of ART therapy, which mimics treatment of chronic HIV-1 infection in humans. These macaques were infected with SIVmac239 for more than 5 years, and highly pathogenic SIV-infected macaques have been well-validated as a stringent model to recapitulate HIV-1 pathogenesis and persistence during ART therapy in humans. Indeed, in our Chinese rhesus model, ART treatment effectively suppressed SIV infection to undetectable levels in plasma, and upon ART discontinuation, virus rapidly rebounded, which is very similar with that in ART-treated HIV patients. We think the results of this pilot study were very promising for further studies which will be expanded the scale of animals and then to preclinical and clinical study in our next projects. Thank you for your understanding.
(2) As well known, ICP34.5 is a neurotoxicity factor that can antagonize host immune responses, and previous studies have shown that the safety of recombinant HSV-based vector can be improved by deleting ICP34.5. In this study, we also found that HSV-DICP34.5 exhibited lower virulence and replication ability than its parental strain (HSV-GFP) (Figure 1D, Figure S1). In addition, HSV-DICP34.5 induced a lower level of inflammatory cytokines (including IL-6, IL-1β, and TNF-α) in primary CD4+ T cells from PLWH compared to HSV-GFP stimulation, likely due to its lower virulence and replication ability (Figure 1I-K). In addition, the CD4+ /CD8+ T cell ratio (Figure 5I) and body weight (Figure S9) after treatment were effectively ameliorated in the SIV-infected macaques of the ART+HSV-DICP34.5-sPD1-SIVgag/SIVenv group. Our data also demonstrated that there was no significant effect on the cell composition of peripheral blood in the SIV-infected macaques of ART+HSV-sPD1-SIVgag/SIVenv group (Figure S10). Thus, these data suggest the safety of HSV-DICP34.5 in PLWH might be tolerable. We have added the corresponding description in the revised manuscript.
(6) Discuss the potential of inflammatory HSV vaccines to be used in PLWH without clinical symptoms.
Thank you for your mention. As discussed above, we found that HSV-DICP34.5 exhibited lower virulence and replication ability than its parental strain (Figure 1D, Figure S1), and we also found that HSV-DICP34.5 induced a lower level of inflammatory cytokines (including IL-6, IL-1β, and TNF-α) in primary CD4+ T cells from PLWH compared to HSV-GFP stimulation, likely due to its lower virulence and replication ability (Figure 1I-K). In addition, the CD4+ /CD8+ T cell ratio (Figure 5I) and body weight (Figure S9) after treatment were effectively ameliorated in the SIV-infected macaques of the ART+HSV-DICP34.5-sPD1-SIVgag/SIVenv group. Our data also demonstrated that there was no significant effect on the cell composition of peripheral blood in the SIV-infected macaques of ART+HSV-sPD1-SIVgag/SIVenv group (Figure S10). Thus, these data suggest the safety of HSV-DICP34.5 in PLWH might be tolerable. We have added the corresponding description in the revised manuscript.
Reviewer #2 (Recommendations For The Authors):
I think the authors have done due diligence to the experimental system, and collected evidence to show the feasibility of delaying virus rebound in macaques. However, I would encourage the authors to perform experiments that can back up the claim that delayed virus rebound is due to neutralization effects, or perhaps due to a reduction in viral reservoir. I believe insights into this process will add rigor, and push the relevance of the study to the next level.
Thank you for your nice comment and valuable suggestion. We have now provided more data about this issue. We found significant suppression of total SIV DNA and integrated SIV DNA provirus in the ART+HSV-sPD1-SIVgag/SIVenv group. However, the copies of the SIV DNA provirus were significantly improved in the ART+HSV-empty group and ART+saline group (Figure 5F-G). We also discussed that incorporating the induction of broadly neutralizing antibodies into our future optimizing approaches may lead to better therapeutic outcomes in the revised Discussion section. We have added the corresponding description in the revised manuscript. Thank you.
Altogether, all of the above comments and suggestions are very helpful in improving our manuscript. We have taken these comments into account seriously and try our best to address these questions point-by-point. After making extensive revisions, we now submit this revised manuscript for your re-consideration. Thank you again for all of your comments and suggestions.
